Respectful Insolence

Gotta have more woo in my medical school!

Another one has fallen.

Yes, another prestigious medical school has given in. First I lamented the decline in basic science education in medical schools. Then, I lamented even more the infiltration of woo into the curricula of far too many medical schools, spurred on by patient demand, a desire for a nice, high profit cash-on-the-barrelhead set of treatments, and, most depressing of all, the misguided and highly credulous advocacy of the American Medical Student Association (AMSA). Worse, my own alma mater, the University of Michigan, has infiltrated serious woo into its curriculum. But at least U. of M. still leaves its woo as fourth year electives. Not so Georgetown, where woo is being fully integrated into the mandatory curriculum with a disturbing enthusiasm. Not surprisingly much of this infiltration is being funded by the National Center for Complementary and Alternative Medicine (NCCAM).

And Dr. RW informs me that now we have UCSF joining the pack.

Of course, UCSF puts a disclaimer in The UCSF Guide to Integrative Medicine stating:

Inclusion of a therapy, resource, or practitioner in this guide does not imply endorsement by UCSF, the Integrative Medicine Network, or the Osher Center for Integrative Medicine.

Too bad this disclaimer and the frequent mention that there is no good randomized clinical trial data demonstrating the efficacy of most of these treatments is belied by the utterly credulous description of various alt-med modalities found in many of the chapters. For example, check out this description of acupuncture:

Acupuncture relies on the idea of Qi, the energy force that run in regular patterns called meridians through the body. A person’s health is influenced by the flow of Qi in the body, in combination with the universal forces of Yin and Yang. If the flow of Qi is insufficient, unbalanced or interrupted, Yin and Yang become unbalanced, and illness may occur. By inserting fine needles on the body’s surfaces at specific points to connect the meridians, acupuncture is used to regulate or correct the flow of Qi to restore health.

At the initial visit, the practitioner evaluates the patient’s current problems, medical history, available laboratory values and radiological tests, as well as a traditional physical exam of the tongue, reflex points, radial pulse, and external ear. The goal of the evaluation is to link the patient’s problems to a specific imbalance or block of Qi

Note how the description of qi is described as fact, not as an explanation that has no scientific basis for whatever effects (if any) acupuncture has on pain or disease in humans. Even in the section on scientific studies, there is no mention that qi has never been measured or detected, despite many attempts. But the description of acupuncture isn’t that bad compared to some others. At least acupuncture has a potential physiologic mechanism for doing something. (What, I’m not sure.) Not so, homeopathy, but that doesn’t stop the fine folks at UCSF from serving up another heapin’ helpin’ of credulity:

Dr. Hahnemann first formulated his principle of the Law of Similars after testing quinine, a cure for malaria. He found that it produced the symptoms of malaria in a healthy individual. However, when he discontinued the quinine, the symptoms disappeared. After several similar studies, Hahnemann found that very small doses of the substance are nontoxic and yet still work to produce the desired symptoms of the illness in healthy individuals. Homeopathic remedies are therefore diluted to different degrees so that only traces of the original substance are present. Often chemical testing will show no presence of the active ingredient. This, however, is completely consistent with homeopathic philosophy as they believe that the ingredient leaves an imprint on the remedy and it is this ghost print which then acts within the body.

In the discussion of research into homeopathy (now there’s an oxymoron!), not a word is mentioned that homeopathy is chemically and pharmacologically impossible, something that was appreciated by most scientists as far back as the 1840′s.

Worse still are the testimonials, just as good as that of any altie website. Here’s one from a patient:

“By the third day I felt so much better physically I was able for the first time to walk down the stairs, then up the stairs, then I was able to cut my pain medication in half.” –Fibromyalgia patient after having received two months of Ayurvedic cleansing treatment, massage, diet and nutrition consultation and herbal treatments.

Here’s one from a Reiki practitioner:

“I am a Second Degree Reiki Practitioner of the Mikao Usui Tradition. In the 10 years of my Reiki practice I have seen healing transformations in all my clients, on all levels (mental, emotional, spiritual, and physical). One patient that stands out most is a nurse for the U.S. Embassy that had been suffering from Shingles for nearly three years. After several hospitalizations and medical evacuations for treatment, she called me for an appointment. She was on daily doses of morphine painkillers, was exhausted and in pain all the time and had gained a lot of weight. We began weekly Reiki treatments that lasted for about six months. During the six months, she first began sleeping well, feeling more energetic, reducing her morphine and ultimately eliminating all pain medicine, and arriving at full energy balance and recovery.” — Lauretta Agolli, Reiki Practitioner

This, of course, follows a credulous description of what Reiki is, although at least the manual does mention that “Reiki is not recommended as the sole treatment for potentially serious medical conditions, and its use should not delay the time it takes to consult with a health care provider or receive established
therapies.”

Well, that’s a relief after that lovely testimonial and the glowing description of Reiki that preceded this disclaimer.

Of course, no bit of woo would be complete without a bona fide endorsement form a Nobel Laureate. After all, Vitamin C quackery had Linus Pauling, and arginine has Dr. Louis J. Ignarro. And the Alexander Technique, a technique that seems to be ergonomics for which amazingly overblown claims of benefit are made, has this:

“I recommend the Alexander Technique as an extremely sophisticated form of rehabilitation… From personal experience we can already confirm some of the seemingly fantastic claims made by Alexander and his followers– namely, that many types of under-performance and even ailments, both mental and physical, can be alleviated, sometimes to a surprising degree, by teaching the body musculature to function differently. We already notice, with growing amazement, very striking improvements in such diverse things as high blood pressure, breathing, depth of sleep, overall cheerfulness and mental alertness, resilience against outside pressures and in such a refined skill as playing a musical instrument.” — Professor N. Tinbergen, 1907-1988, Nobel Prize for Medicine, 1973

Given that Professor Tinberg also seems to have embraced the now discredited “refrigerator mother” concept of autism, perhaps he isn’t such a great spokesperson for topics outside his area of expertise. (What won him the Nobel Prize was ethology.) Indeed, Prometheus had an amusing take on Dr. Tinbergen’s judgment when it came to embracing dubious hypotheses outside of his field:

In his Nobel lecture, Tinbergen – freshly hung with his Nobel wreath – ventured to explain autism as a response to environmental stress, ala Kanner and Bettleheim.

In doing so, he not only hopped on the “Refrigerator Mother” hypothesis of autism as it was sinking, but he also managed to set a nearly unbeatable record for shortest time between receiving the Nobel Prize and saying something really stupid about a field in which the recipient had little experience. Tinbergen thought that his experience – and it was vast experience – in animal behavior gave him special insight into autism. It might have, but it didn’t.

I could go on, but what’s the point. The UCSF manual has credulous and, in some cases, promotional treatments of a wide variety of woo, including reflexology, Reiki, naturopathy, fasting, spiritual healing, and others, mixed in with the occasional less woo-filled modality, like biofeedback. But what disturbed me even more was some of the descriptions of treatments for specific diseases, for example cancer (of course). Take a look at this schizophrenic passage:

Alternative therapies may be dangerous because they are often unproven and administered in lieu of traditional treatment such as chemotherapy or radiation. Using alternative therapies instead of conventional treatment for highly curable, early-stage cancers is not recommended.

CAM therapies are also considered useful approaches to recurrence, metastatic cancers, and secondary cancers.

In actuality, as far as the cancer goes, alternative therapies are no more useful for curing recurrent or metastatic cancers than for curing early stage curable cancers.

Worse, there are yet more credulous descriptions of all manner of cancer woo, including megavitamins, “colon detoxification’ with coffee enemas (as in the Gerson/Kelley/Gonzalez protocol), antineoplastons, The same is found for all the other diseases discussed individually, all with liberal comparisons between the woo and the dreaded “allopathic” medicine.. Indeed, the only altie woo that, to its credit, the UCSF manual does not mention is chelation therapy. All of this is topped off with an interview with two doctors, Silver Quevedo, MD and Daphne Miller, MD, both of whom give advice on how to integrate woo into conventional medical practices. I think that the best advice came from Dr. Quevedo:

We did not have a very happy experience in San Jose with insurance companies. We actually began to opt-out of managed care and give patients a statement, a super bill with diagnostic codes that they submit as a claim form to their insurance companies, and they pay us directly. So we’ve sort of taken the insurance companies out of the middle, and interestingly the patients seem to be getting paid better by the insurance companies than we were. Basically, the patients have to go out of network if they’re going to see us. Now the ones that have been doing it, they’ve been happy to do it.

And, I’m sure, the doctors integrating such woo into their practices are even more happy to take the money.

Sadly, the infiltration of such non-evidence-based modalities into the medical school curricula of so many universities continues apace. There’s also an enthusiastic subset of medical students who are more than eager to lap it up. Indeed, check out AMSA’s first ICAM newsletter (embarrassingly for me, edited by a University of Michigan medical student), which shows that these students won’t just lap this stuff up, but will actively promote it.

You know, between “intelligent design” advocates like Drs. Cook and Egnor (both of whom teach medical students) and the increasingly uncritical promotion of non-evidence-based “alternative” medicine, I fear for critical thinking skills among my colleagues.

Comments

  1. #1 Blake Stacey
    February 28, 2007

    Is there any chance of getting a big-name organization of medical folk to repudiate this kind of garbage?

  2. #2 ERV
    February 28, 2007

    And Dr. RW informs me that now we have UCSF joining the pack

    ‘Now’? UCSF was my first encounter with hard-core woo in AMSA, and one of the main reasons I stopped wanting to go to med school several years ago. I was an undergrad arguing over the HuMed list-serve with medical students and PHYSICIANS from UCSF, who were trying to justify their intercessory prayer + breast cancer study. Ive never heard any results from this ‘study’, so Im going to assume that they ‘found’ jack shit, if you can imagine.

    God– breast cancer research money being wasted on that shit– infuriates me to this day.

  3. #3 wolfwalker
    February 28, 2007

    I honestly don’t understand. Where is all this woo coming from, and why are medical schools suddenly becoming so susceptible to it?

  4. #4 jeffk
    February 28, 2007

    I always get frustrated with doctors – I think they’re terrible scientists and thus are usually bad at their jobs. I’m a physics grad student/TA, and our “intro physics for bio majors” has the most terrifyingly awful students – the ones that want to know the formulaic method for finding a solution to a given type of problem, rather than understanding it. The sad truth is that, in my experience, the medical profession attracts the worse people. This is, of course, a generalization.

  5. #5 Joe
    February 28, 2007

    @Blake Stacey, Over at TerraSig, Abel just posted a note that JAMA has an annual issue concerning medical education. The deadline for papers is March 1, publication in September. It would be nice if they got a bunch of complaints this year, or next. It is a tad late for this year.

  6. #6 Davis
    February 28, 2007

    It doesn’t really surprise me to see woo cropping up someplace like UCSF — the west coast seems to be hotbed for fuzzy thinking. Here in Seattle we even have Woo College, aka Bastyr University. People around here hold it in high regard.

    However, that doesn’t explain why it’s appearing in places like Georgetown and U of M.

  7. #7 Joseph Hertzlinger
    February 28, 2007

    Is it true that Reiki rhymes with flaky?

  8. #8 Bribes
    February 28, 2007

    The reason med schools are offering alternative medicine theories are mainly because there’s a demand for them. With rising healthcare costs and ridiculously complicated medicine, people look for cheaper, more intuitive answers. And, of course, when western medicine has no answer, people will look elsewhere. This doesn’t mean those answers are legitimate, but it does explain the demand.

    Also, modern, Western medicine focuses mainly on acute, purely physiological care. There’s a big blind spot for chronic, mind-body care. Things like basic qi, massage, meditation, yoga, etc., address long-term chronic issues that modern medicine usually glosses over. Perhaps you think it’s simply included in the field of ergonomics and physical fitness. In that, I respectfully disagree. The key to the alternative theories is that they espouse more than just the physical body. There is a physical, emotional, and mental aspect to practicing these techniques, as well as fuller body awareness, which is missing from standard ergonomic and physical fitness regimes.

    As for the legitimacy of these alternative medicines, it depends upon the alternative medicine regime. You seem to bunch them all together. I’m very skeptical of the more esoteric practices and claims, but things like yoga make a lot of sense to me.

    Considering how widespread these alternative treatments have become, there is definitely a need to get at least a passing knowledge of the subject matter, and thus include them in medical school curricula. But, it must be done with the proper skepticism.

  9. #9 Anna
    February 28, 2007

    Where does this stuff come from, people ask. It is the response to a groundswell of demand. Newsflash: people are dissatisfied with doctors.

    I have no sympathy for all the “woo is me” doom and gloom. The fact is doctors do not take the time to really understand the patient and work “with” them to improve health.

    Especially for chronic conditions. Especially “imaginary” ones like PMS or fibroid tumors. Right. Just remember that people who are told they have an “imaginary” condition are ripe for “imaginary” cures.

    It is a matter of respect.

  10. #10 factician
    February 28, 2007

    As an undergrad I signed up for a Reiki class. I had no idea what it entailed, it was free and subtitled “Japanese massage”. I figured learning this stuff would give me great skills for picking up women in the dorm I lived in. So a buddy of mine and I went to this intro class. Talk about woo. They were spouting irrational crap up the wazoo (and there was an M.D. that was co-hosting the event, to my great surprise). They kept talking about energy flowing out of peoples’ hands, and that this would give you good dreams. At the end of the session, they asked who wanted to fork over $400 for a full weekend of this crap. My buddy and I were the only ones who declined. I’ve never forgotten the teacher’s signature proof that Reiki was magical. “After I’m done with a session, my dog comes and lies on the massage table, absorbing the good energy. That’s how I know this works.”

  11. #11 Ben
    February 28, 2007

    It’s the sexy thing for medical schools to do these days. It’s all the rage for reasons that are unknown even to themselves. My medical school is undergoing a curriculum change currently, and I sincerely hope that we don’t go the way of UCSF and Michigan, much less Georgetown, which is absolutely vomit-inducing. Quick! Someone apply pressure to the area 3 inches below my left and see if that helps the nausea!

  12. #12 Brian
    February 28, 2007

    Well, I guess it’s the latest strategy for the health care industry to increase profits by cutting costs – dumber physicians and less effective therapy.

    BTW,

    the west coast seems to be hotbed for fuzzy thinking

    is a very nice example of fuzzy thinking – are you on the west coast?

  13. #13 Rev. BigDUmbChimp
    February 28, 2007

    I honestly don’t understand. Where is all this woo coming from, and why are medical schools suddenly becoming so susceptible to it?

    Does it really surprise anyone that all this pseudo-science is gaining traction given the wanton abuse that science is taking in so many broad fields?

  14. #14 anonimouse
    February 28, 2007

    It doesn’t really surprise me to see woo cropping up someplace like UCSF — the west coast seems to be hotbed for fuzzy thinking. Here in Seattle we even have Woo College, aka Bastyr University. People around here hold it in high regard.

    I clicked on their website and noticed their president died of a heart attack. At 60. Guess even being the head of the woo patrol doesn’t guarantee you long life, huh?

  15. #15 Thony C.
    February 28, 2007

    “I honestly don’t understand. Where is all this woo coming from, and why are medical schools suddenly becoming so susceptible to it?”

    MONEY, MONEY, MONEY and more MONEY.

  16. #16 Sastra
    February 28, 2007

    Alternative medicine offers two things which conventional medicine cannot:

    1.) a “spiritual” component that reaffirms your intuitions that you are connected to the universe, and it is on your side and wants to help you
    and
    2.) a reinforced sense that you are an independent pioneer, someone who is willing to buck authority and “take charge” of their own health.

    As an atheist who sometimes debates online, I keep running into people who think that naturalism has been scientifically disproven, and God’s existence reasonably established. How? They point to the medical profession and its increasing embrace of alternative medicine. Vitalism is a form of spirituality. I strongly suspect that one of the big motivations underlying belief in alt med is the same as the motivation underlying belief in the paranormal: religion.

    This is the power of religion. Good luck fighting it back again with science once it establishes a foothold.

  17. #17 HCN
    February 28, 2007

    Brian said “is a very nice example of fuzzy thinking – are you on the west coast?”

    The next sentence after the one you quoted was “Here in Seattle we even have Woo College”.

    Yes, Seattle is in a west coast state. Though it is not actually on the coast, it is on Puget Sound which does go to the Pacific Ocean.

  18. #18 Koray
    February 28, 2007

    This is absolutely horrible news.

  19. #19 MJ Memphis
    February 28, 2007

    “After I’m done with a session, my dog comes and lies on the massage table, absorbing the good energy. That’s how I know this works.”

    Funny, that. I could use the same sort of logic to prove that the contents of my cat box are full of good energy; after one of the cats is finished with a “session”, my house dog makes a beeline for the litter box to obtain some… err… “good energy”. Obviously doggie knows best. Think I could convince a med school to teach my new Qi Cat Poo therapy?

  20. #20 PlanetaryGear
    February 28, 2007

    yes, but I fail to see where the money is going to come from. Will your insurance pay for woo? As more and more doctors start getting paid for performance or other horrible things, how will that shake out for docs that spend a lot of time and effort doing things that will not affect the outcome on paper. Perhaps his entire population of woo lovers will be thrilled with him, but he’s going to get dropped by the insurance companies.

    So only those with money will be able to pay for the woo-ments and the rest of us will have to settle for treatments paid for by our insurance companies. Which will end up with a huge dividing line in care ;) So the wealthy people will start to die off of curable problems, and the poor will thrive until there is nobody left to pay for their treatments…

  21. #21 IP
    February 28, 2007

    How funny.

    Last nite I spent three hours searching this shit up in regards to Peds med, at the Stollery in Edmonton. Orac, I could throw up with what I have read. I need a couple of hours to write what I found out up, but suffice it to say, after I read everything I wanted to gouge my eyes out with forks. And set my head on fire.

    I have not yet composed my thoughts past convincing myself not to do the above things.

    This is also the university/hospital that funds the Hope Foundation of Alberta to the tune of a couple million a year. Hope heals, apparently.

    Can you please do a post on orthomolecular medicine as it has come up often in the “course of studies” I have embarked on as a layperson. Or have you already?

    Real life calls.

  22. #22 Garrett
    March 1, 2007

    As a 4th year at UofM right now, I’m sorta shocked about ignorant you all seem to be about the actual role of CAM training in med schools. We’re not learning CAM so we can “prescribe” that shit. We’re not turning into a DO school. We’re learning how to evaluate evidence, we’re learning how to keep our patients from killing themselves with their vodka/black cohosh martinis they drink every morning during their yoga session, and we’re learning a little bit about how folks who haven’t been to medical school think about their health, which might come in handy, since we’re trying to keep these folks from imploding in their own ignorance.

    Even the 4th year elective in CAM, which a few of my friends have taken, isn’t so much about suggesting weird shit when evidence-based stuff would make more sense. It’s mostly just a context in which primary care docs actually have more than five minutes to deal with all 27 of a patient’s complaints. The most “alternative” thing about that rotation is that a patient and a physician actually gets to have something that resembles a human conversation.

    We aren’t any less skeptical of CAM than you folks who trained before us. In fact, the quality of our EBM and epidemiology training probably smokes whatever you folks had before EBM became such a buzz, and I bet the average 4th year now can do a hell of a better job reading an academic paper than the average 4th year ten years ago.

    Our “comprehensive” CAM curriculum is still pretty shallow and doesn’t take up all that much time. It’s still an afterthought, and at its worst a little entertaining. You should see a chiropractor trying to convince a room full of medical students that he isn’t completely full of shit. They should sell popcorn!

    Sure, the med schools have to “sell” their CAM curricula as being a little more sensitive for the hippie-nuts reviewing the educational grants. But believe me, healthy skepticism is in effect. Med students haven’t changed that much, and our bullshit detectors still have fully charged batteries.

  23. #23 Thony C.
    March 1, 2007

    “yes, but I fail to see where the money is going to come from?”

    Germany has an extensive and on the whole good state medical system which is free for all who pay their medical insurance which is compulsory for all workers. However an incredibly large number of my acquaintences, all intelligent well educated people, pay a fortune for treatment by all sorts of purveyors of alternative woo.

  24. #24 bcpmoon
    March 1, 2007

    it is this ghost print which then acts within the body.

    A ghost that´s healing? I knew it…
    Also, saying

    traditional treatment such as chemotherapy or radiation

    is interesting, as woo is also often labelled as “traditional”…

  25. #25 anonimouse
    March 1, 2007

    Garrett,

    I think for the most part, I agree with you based on my experience at the medical school I’m associated with.

    However, when CAM is taught uncritically (and believe me, it IS taught uncritically in some schools) students can get caught up in the idea that some of the less woo-sounding stuff DOES have scientific validity because they don’t have the requisite basic science background to know otherwise. Combine this with a push by some med schools to further dilute the basic science curriculum (so they can reduce the number of years in school from 4 to 3) and you’ve got a serious problem brewing.

  26. #26 Garrett
    March 1, 2007

    I never said CAM was taught critically here either. It’s certainly not. We have NDs and homeopaths and reiki practitioners lecture us or lead small groups. None of those folks tell us that the evidence for their modalities are nonexistent. We’re in Ann Arbor, so there is no shortage of such folk.

    They pull out every anecdote they’ve accumulated in their 712 years of practice over their past nine lives to build their case. But, despite what you folks might think, med students aren’t quite the tabula rasa morons you might think we are. We’re not at Michigan, and we’re probably not at UCSF either, or Georgetown.

    Somehow I think I’d still be able to evaluate whether rolfing cured cancer even if I hadn’t had those seven lectures on the intricacies of the golgi apparatus. We still have way more basic science information thrown at us than we could possibly retain past Step One. Until that’s no longer true, worries about med students not getting sufficient basic science training seem a little misplaced.

  27. #27 Brian
    March 1, 2007

    Brian said “is a very nice example of fuzzy thinking – are you on the west coast?”

    The next sentence after the one you quoted was “Here in Seattle we even have Woo College”.

    Hmm, call that fuzzy reading – or no thinking…

    Anyway, I’m glad to hear that CAM is often being taught critically, and I would be very surprised if all Med students were totally credulous. But you can’t tell me there aren’t a few, and with them listening to pro-altie speakers, it only raises the odds that a few more will slip in in the next generation.

    My experience in the German medical system (generally very positive) is that many physicians offer acupuncture and homeopathic remedies simply because patients demand them, but it’s a very fine line between that and just offering them because, what the hell, other patients wanted/liked it.

    My wife ended up getting acupuncture from her OB/GYN for her sciatica, and while we were both pretty upset about it, neither of us wanted to alienate our otherwise very competent and helpful physician by complaining to him about quackery.

    I think these things just start to creep once they are tolerated, and so any non-critical presentation of these “remedies” are ill-advised.

  28. #28 GoBlue
    March 1, 2007

    I am a medical professional.

    Buried subtly in your argument is an Anglo-rooted hubris that is, frankly, rooted in prejudice. The entire history of “woo” is rife with perverted characterizations of people of color, and your attempts to link them all smacks of implicit racism. Please wiki < http://en.wikipedia.org/wiki/Fascism> the word “fascism,” and you will find a searing characterization of how allopathic medicine has come to its present-day state.

    You are welcome to stereotype every practitioner out there, and extrapolate that to encompass an entire demographic. You might as well say it: “Ayurveda was developed in India. Those people are uneducated tribals, right?”

    Don’t get me wrong here – if I get gunshot wounds, strap up some IV’s and call the surgeon. But there is no “war” here. There are no two sides, and it’s futile to try and create an issue out of nothing – when in fact, you simply are a population that refuses to change…

    Alternative medicine, when proven, becomes a part of mainstream therapy. End of story. What’s funny is that even when something is proven, you either:

    A. Deny it
    B. Find a way to discredit the evidence (i.e. holding it to a double standard)

    So your beliefs seem to be stagnant for decades just for the sake of “sticking to your guns.” Sounds like George W. Bush. Perhaps it is time to take a page out of the Mitt Romney playbook. Lighten up, will ya – don’t be afraid to flip-flop.

    Do you prefer “evidence-less” modalities? The ones that make up, oh, let’s just throw it out there – 40% of modern medicine? They didn’t teach you that at Michigan? They taught us the first week. Do you discredit modalities that don’t fit into the double-blinded placebo controlled modicum? How exactly do make a control for acupuncture? Think about that (it’s been done at Harvard, so don’t think too much). Or wait, would you rather have doctored evidence modalities that threaten the very core of what you call science? Or are you content to let Pharma continue to fabricate (some) trials?

    Oh I get it – you’re waiting for evidence of alternative therapies to turn up in Pharma-sponsored medical journals. Oh I see.

    If you are scared about this changing landscape, look no further than yourselves. The blame lies squarely with your own generation of doctors. And I encourage the above poster to continue using his wife’s experience with a sole acupuncturist reason enough to discredit the entire field. Scientific, indeed.

    Calling alternative medicine practitioners greedy is a little bit like the pot calling the kettle black, no? Why act as if allopathy is taking the higher road…why not lay it all out there? As if no radiologist has ties to diagnostic imaging modalities and no incentive to order tests, or no surgeon has incentive to operate on nonsurgical patients. Because there definitely no unnecessary procedures or interventions in conventional medicine. Right? Every surgery performed in the United States is completely and rationally decided, backed by evidence.

    Where exactly did you train?

    An unnecessary surgery can destroy a life. Unnecessary acupuncture ain’t exactly lethal, buddy. So even on that end, your “woo woo” scare tactic isn’t exactly consequential. People can be afraid of their lives when they step into a hospital, and for good reason. Now they may need to be there, but take the blinders off to that fact – people can be scared out of their wits.

    Our healthcare money is so efficiently well-spent in this country, so I encourage you to preserve the status quo. Go ahead defending the present day, and the answer is clearly to wage war on preventive medicine and integrative medicine.

    In reality there is no “us” and “them.” Please forgive the AMSA wingnut plebians for trying to bring back a little humanity into medicine. After all it’s so fascinating to spit out algorithmic pharmacopia for every single patient, because all patients are obviously the same. Obviously, when 80% of clinical trials come back with POSITIVE outcomes for the drug of the company that sponsors them, you’re not worried.. That’s not corruption.

    We agree on one thing, boss. Medical education is in a piss poor state. I await the day when more of the integrative, proven modalities are given their rightful place besides certain inferior drug treatments.

    p.s. Only 60% of allopathic medical decisions have literature supporting it. This was taught to us at Michigan Medical School. Or should I say Michigan Medical Skoo’, as we are now ghetto.

    p.p.s. Can you read Chinese? It will give you access to some acupuncture evidence. Or wait, is that one of your requirements, that all evidence has to be in English?

    p.p.p.s. Allopathic medicine is the great, logical, proven choice for the 20% of patients that need acute care.

    p.p.p.s. Allopthic medicine can fail miserably for chronic conditions. You know this well, but you continue to beat the war drums.

  29. #29 Sarken
    March 2, 2007

    When all of you brilliant allopathic physician types come up with a way to measure qi in a teaspoon or by the cc, then not only will the acupuncturists finally be ‘proven’ right, but you’ll be crying from humiliation in your green tea. Your way is not the only way, and your attititude and disrespect for alternative ways of achieving health only punctuate the youthful arrogance of the medicine you practice. And when you do finally ‘prove’ qi, because randomized clinical trials are the only way you can feel safe in believing in anything, the acupuncturists’ patients may stop feeling as though they must lie to their MDs. ;)

  30. #30 Harvey
    March 2, 2007

    Why make such a big deal about this? Why act as if medical schools and physicians are letting you and everyone else down? We certainly don’t understand the mechanisms of many, MANY disease processes so why act as if someone is doing something wrong?

    Medical education is not in a bad way, it is just trying to get 5 or 6 years of education into a 4 year program. Constructive comments and efforts will do more to help the problem.

    Physicians are not the enemy, they are doing the best they can with what they have. If you took a poll of your medical school classmates or fellow physicians, would they say they aren’t interested in making things better. By and large they want the best for the patient. We just don’t have many of the answers…yet.

    Woo is not a disease, anathema or end all/be all. It is just a way to treat a patient (for good or bad) that seems to validate the patient more than the conventional methods do. Still, many physicians treat their patients with the greatest of respect and give due heed to their needs/complaints.

    So, is woo something that should be taught in medical schools as a viable form of scientific treatment? Only if it can be substantiated scientifically. But, the underlying spirit of woo is very necessary for a great number of patients and should be emphasized somehow in medical school. That is, people get better when they feel that someone has taken them seriously and respectfully guides their healing process. True this is a great generality but one that has been scientifically shown to have merit. If you say “What about HIV or Hepatitis,” I haven’t personally seen much info but there is a tremendous log of validated information on the use of the “human touch” in everything from cancer to the common cold, as an adjunct to more mainline treatments.

    If the only way to get physicians/medical students to take the “woo spirit” seriously is by giving them a “formulaic” method like acupuncture or meditation or…the list goes on, then it is a good thing to have an exposure to these methods in medical school.

    As healers, we can’t doubt ourselves or we will not perform as well. Sometimes that makes us unwilling to investigate something outside of our realm of security (the straw house we build to help us maintain our confidence). Woo is a good thing in that it will help us to eventually grow and become better care providers. It can be a bad thing if we adhere to it as a means of pushing back our insecurities when it comes to treating others.

    We don’t know all the answers…we don’t even know most of the answers. That is hard to face sometimes because the vast majority of us want desperately to help others have a better existence. We must read the journals. We certainly need to learn from our peers but I think the most important thing we can do for a patient is give him/her the respect they deserve, even if we don’t like them. They have been humbled by admitting to themselves and us that they are unable to take care of themselves. The most awful thing we can do is treat them as if they do not matter.

  31. #31 Davis
    March 2, 2007

    Buried subtly in your argument is an Anglo-rooted hubris that is, frankly, rooted in prejudice. The entire history of “woo” is rife with perverted characterizations of people of color, and your attempts to link them all smacks of implicit racism.

    Give me a break.

    If anything, it is the woo-supporters whose position is rife with racism and perverted characterizations — to them, eastern cultures are mystical and mysterious, drawing on ancient wisdom unavailable to those of us in the west (see, for example, “qi”). It smacks of the old “noble savage” drivel, and ignores the complexities inherent in all cultures.

    The rest of your post makes me suspect this is the first time you’ve ever read this blog, since the relationship between your characterization of Orac and what he has actually said in the past seems to be purely incidental.

  32. #32 K
    March 2, 2007

    Garrett,

    You’re a hypocrite.

    You spent all that time defending your program from ignorant critics, yet you did the same thing when you insulted DO schools.

    Maybe you should spend more time researching your comments and less time impulsively venting your potty mouth, like a doctor should.

  33. #33 anonimouse
    March 2, 2007

    Garrett,

    I know you’d like to think that the basic sciences you learn in the first two years are adequate. They probably are. But the general direction of med schools is to move to a more “clinical-based” curriculum. (many schools already operate this way) That means that you get fewer basic science lectures and more hands-on experience. In theory, that’s a great idea, as they get to see more patients and more clinical cases from the get-go. In practice, it leaves doctors with a weaker scientific base of knowledge that leaves them susceptible to scientific-sounding woo.

    Sure, you might be smart enough to discern the nonsense. So might most of your classmates. But believe me, there’s a segment of your class – and every class – that has the capacity to swallow that stuff hook, line and sinker.

    It’s one thing to understand common woo in order to be prepared when a patient comes in wanting to try it (or is already trying it). It’s another to be “sold” it within the context of a medical school.

    GoBlue,

    Name specific examples of “allopathic” medical practices that are:

    -commonly used
    -endorsed
    -NOT supported within the scientific literature (either through randomized trials, clinical experience, etc.)

    Otherwise, your entire post is little more than a straw man.

    Harvey,

    There are plenty of ways to impress upon medical students the importance of communication and building patient relationships without delving into woo.

  34. #34 Orac
    March 2, 2007

    I never said CAM was taught critically here either. It’s certainly not. We have NDs and homeopaths and reiki practitioners lecture us or lead small groups. None of those folks tell us that the evidence for their modalities are nonexistent. We’re in Ann Arbor, so there is no shortage of such folk.

    They pull out every anecdote they’ve accumulated in their 712 years of practice over their past nine lives to build their case. But, despite what you folks might think, med students aren’t quite the tabula rasa morons you might think we are. We’re not at Michigan, and we’re probably not at UCSF either, or Georgetown.

    And you’re defending that? Having chiropractors and Reiki practitioners lecture without any scientific counter point in a school that’s been devoted as long as I can remember to science and evidence-based medicine?

    Maybe your class has a lot of skeptical medical students (and congratulations to you all if that’s true!), but how do you know that subsequent classes will? After all, as an uncritical view of this stuff gets more and more established in the curriculum, coupled with AMSA woo-meisters pushing it, medical students will come to accept it as an unremarkable part of what they need to learn, particularly if it ends up in the mandatory medical curriculum, as it has at Georgetown. Medical students will do with it what they’ve done with most things they’re taught since time immemorial: memorize it, learn it, and regurgitate it for the tests without much thought. (I graduated from U. of M. Medical School, remember, and that’s what medical students did there as they do in most medical schools, at least in the first two years.)

    As for your later statement that you learn “way too much basic science,” I submit that the problem is not the amount of basic science taught but how it’s taught: As a lot of memorization and application of formulas (blood gases, etc.) as facts to learn and techniques to apply to problem-solving without much understanding of the mechanisms behind them and the scientific method for examining claims. Indeed, I had taken graduate level biochemistry before I entered medical school. Because of that, I was placed in the”advanced” medical student biochemistry course (they didn’t let people test out, unfortunately). I was shocked at how watered down the version taught to me was. In fact, I got into trouble for thinking too mechanistically, rather than just memorizing the Krebs’ Cycle. You don’t realize it now, but the way science is taught in medical schools is often appalling.

    I fear for my alma mater; if it expects me to donate to the alumni fund while it promotes this crap, it’s going to be sadly disappointed.

  35. #35 Orac
    March 2, 2007

    I am a medical professional.

    But apparently not a physician or not yet a physician; otherwise you would probably have said that you were. Here’s a hint: If you’re a medical student, you’re not a medical professional yet; you’re training to be one. And apparently you need a lot of training, regardless of what you in fact are.

    Buried subtly in your argument is an Anglo-rooted hubris that is, frankly, rooted in prejudice. The entire history of “woo” is rife with perverted characterizations of people of color, and your attempts to link them all smacks of implicit racism. Please wiki the word “fascism,” and you will find a searing characterization of how allopathic medicine has come to its present-day state.

    You are welcome to stereotype every practitioner out there, and extrapolate that to encompass an entire demographic. You might as well say it: “Ayurveda was developed in India. Those people are uneducated tribals, right?”

    Bullshit.

    I’m an equal opportunity skeptic. Race or origin of the woo matters not one whit to me. For example, ask yourself: What alt-med “therapy” do I rant against the most often on this blog? Which one do I consider so risible, such utter bunk, that I post on it again and again? It ain’t Ayurvedic medicine (although much of that is bunk, too, and such medicines have a distressing propensity to be contaminated with heavy metals.)

    No, it’s homeopathy, invented by a German physician and primarily promoted by Western alties.

    Now, ask yourself, what alt-med practitioner have I ever openly labeled as a quack? Nope, it ain’t any Eastern or Indian woo-meister.

    It’s that nice Canadian quack who thinks that the intestinal fluke is the cause of all cancer and sells a “Zapper” to kill it, Hulda Clark.

    And, as was said in response to you in another comment, many of the views of woo-supporters seem rife with subtle racism and perverted characterizations: the mystical and mysterious East and its mysticism, as well as the “noble savage” concept or the concept that, because it comes from “ancient wisdom” from the East, there must be something to it.

    As for the rest of your rant, it’s all out of the altie playbook and very tiresome to boot. Your appeal to the imperfections in “allopathic” medicine rests on the rather obvious fallacious argument that, just because “conventional medicine” isn’t 100% evidence-based, doctors have no right to criticize evidence-free varieties of alternative medicine like homeopathy for being ineffective and, apparently, that using these evidence-free altie treatments should be just as OK as conventional medicine. Now there’s a great way to improve the percentage of evidence-based medicine in “conventional” medicine! No, in reality, what we should be doing is championing evidence-based medicine as much as possible to boost that percentage up, rather than incorporating evidence-free woo into our practices to lower that percentage still further. Of course, it’s obvious from your rant that you have no real interest in evidence-based medicine other than as a cudgel with which to attack conventional medicine. Certainly it’s clear that you have not interest in improving the percentage of EBM in either conventional or alternative medicine.

    Come to think of it, now’s a good time to point this out: I have said time and time again: I reject the entire concept of “alternative medicine” as a false dichotomy compared to medicine. It should all just be medicine and should all be subject to the same standards as far as scientific evidence required to support it.

    Nice try. Come back when you can actually make a coherent argument.

  36. #36 HCN
    March 2, 2007

    Hmmmmm… When I saw GoBlue declare s/h/it “I am a medical professional”, and go and use the term Hahnemann made up as a derisive term to describe what everyone else did, “allopath”… I thought GoBlue was a homeopath.

  37. #37 Sastra
    March 2, 2007

    Sarken wrote:

    When all of you brilliant allopathic physician types come up with a way to measure qi in a teaspoon or by the cc, then not only will the acupuncturists finally be ‘proven’ right, but you’ll be crying from humiliation in your green tea.

    Humiliation? For waiting for proper evidence before drawing a sweeping conclusion?

    I’ll put it this way: if qi energy healers turn out to be correct, and there really is qi energy and it really does heal, then *shame* on them for having the arrogance to promote it uncritically before it was adequately tested and confirmed.

    It’s not about being right in the long run: it’s about recognizing how easy it is to be wrong. Method, method, method…

  38. #38 Soozez
    March 3, 2007

    I’m horrified to see that U of M has embraced the woo. I just checked the website of my alma mater, Cornell University, College of Veterinary Medicine, and was greatly relieved to see no sign of the woo in the curriculum, and the actual words “science-based” utilized in the general program description. I think I’ll send them some alumnus funds and remark that the lack of woo is what keeps my money coming.

  39. #39 proudDO
    March 3, 2007

    Garrett… Before you lump the DO profession into a ‘pile of woo’, do some research and realize that the curriculum includes about as much CAM as the MD schools do (very little in most cases), and a DO is no more likely to prescribe ‘woo’ than an MD. However, we do have the ability to help heal our patients with our hands right there in the office, no prescription necessary.

    Why have you all chosen the medical profession? Was it not to help your patients? What is it exactly that cures a patient that refuses certain procedures and medications because of religious belief? Do you realize that medicine actually has it’s roots in the religious realm, and that in just the last century we’ve gone from purging and bleeding patients to high-tech clinical treatments; from chloroform and ether to ‘tested and safe’ pharmaceuticals? This profession is in existence to serve the population, and we have no future if we don’t meet our patients where they’re at, listen to them, and continually find better ways to treat them. Don’t let your scientific minds close to the possibilities of treatments that you may not understand. Just because you don’t understand it, doesn’t mean that your patient doesn’t, and it certainly doesn’t mean your patients won’t benefit from it. Even if you’re not open to these ideas, have some respect for your colleagues that may be able to do something for patients that you never will.

  40. #40 Orac
    March 3, 2007

    Don’t let your scientific minds close to the possibilities of treatments that you may not understand. Just because you don’t understand it, doesn’t mean that your patient doesn’t, and it certainly doesn’t mean your patients won’t benefit from it.

    Logical fallacy: Argument from ignorance. In other words, just because we don’t have evidence that it works implies that we should assume that it does work. The scientific, skeptical physician requires (1) at least a modicum of scientific plausibility that the treatment might work (something that, for example, homeopathy fails to deliver spectacularly) before considering it seriously and (2) actual evidence that a treatment works before prescribing it.

    No, I “understand,” and that’s my problem with many of these modalities. I “understand” that there’s no evidence for most of these treatments, and that’s what I tell patients in a respectful, nonjudgmental tone.

    Finally, you will never find a word from me bashing D.O.’s or otherwise criticizing them as a group. I have worked with too many of them to do that. Indeed, one of my mentors in my surgical residency, an anaesthesiologist who was the director of the surgical intensive care unit at one of the main hospitals at which I rotated, is a D.O., and he is one of the finest surgical intensivists I’ve ever dealt with. One of the high-ranking oncologists in our cancer center is a D.O.

  41. #41 A
    March 3, 2007

    Why is it that more deaths occur every year in this country caused by doctors, than guns?

    Evidenced-based medicine is far from perfect. It may be the best thing we have right now, but you can’t tell me that a study that proves a certain drug is great for the 25 year old poor medical students, trying to make a few dollars by participating in the study, can apply to the 80 year old patients the drug is actually intended to target. As physicians we need to be able to critically weigh the evidence that exists and decide whether or not it’s beneficial for our patients standing in front of us looking for the answers.

    Things aren’t as black and white as they seem. Alternative medicine may not fall into the mold of ‘evidence-based medicine’ but maybe that means we don’t have an adequate way of testing all ‘medicine’ equally. If this so called ‘alternative medicine’ is medicine at all, I agree that it should be huddled under the umbrella with ‘conventional’ medicine, but maybe we need to modify our testing methods to create an all encompassing ‘Evidence-based medicine.’

    I have to say it’s refreshing to see critical minds at work when determining efficacy of alternative medicine, but I hope we all apply that to the ‘conventional medicine’ we practice on a daily basis too.

  42. #42 Ruth
    March 3, 2007

    I don’t know if it is my D.O.’s training or just her, but she does ask more ‘what else is going on at home’ questions when I or my kids come in sick. She gives meds as needed, but does do more diet/exercise/stress counseling than my old MD did. Is that just changing standards of care?

    I used to work in clinical trials-we are well aware of the differences in drug metabolism of various groups. It is very hard to recruit elderly or pediatric patients for trials. Few parents want to subject their child to untested meds, and most elderly patients have multiple medical problems that make them poor candidates for testing. The system is not perfect, just like democracy. You can help with reform or just complain about the corrupt system.

  43. #43 Davis
    March 3, 2007

    Things aren’t as black and white as they seem. Alternative medicine may not fall into the mold of ‘evidence-based medicine’ but maybe that means we don’t have an adequate way of testing all ‘medicine’ equally.

    Applying the same standards of evidence to all potential treatments is not testing all medicine equally? I have no idea what the heck “equally” means, if not that.

    And if we apply some other standard of evidence, what would that be? Anecdote? Words written in ancient books? Once you have a separate system of evidence, how do you decide which treatments should be subject to that standard, rather than the EBM standard?

  44. #44 HCN
    March 3, 2007

    A said “Why is it that more deaths occur every year in this country caused by doctors, than guns? ”

    And your evidence for this is?

    A quick glance at the tables show that up to age 44 the greatest cause of death are auto accidents, and from then on are typically age related things like heart disease and cancer. Those are not typically caused by doctors… and indeed many of those lives may have been extended by medical care.

    Also, it is a stupid arguement to compare anything to “gun deaths”, because that is really not a terribly large statistic to begin with. Especially when compared to motor vehicle accidents.

    Ruth said “I don’t know if it is my D.O.’s training or just her, but she does ask more ‘what else is going on at home’ questions when I or my kids come in sick. She gives meds as needed, but does do more diet/exercise/stress counseling than my old MD did. Is that just changing standards of care?”

    It may be just her, or sometimes it may just some doctors don’t like the drug first bit. I go to a family practitioner who will only prescribe meds, and is definitely wants to how things are at home — but that is part of a family type practice. I think you see this in Dr. Charles examining room at http://scienceblogs.com/drcharles/ .

  45. #45 HCN
    March 3, 2007

    Oh, I forgot to add the linky to a site that has death statistics. It is a bit out of date, but still things haven’t changed that much over the past 10 years (except there are fewer cancer deaths):
    http://www.disastercenter.com/cdc/

  46. #46 lemonade39
    March 3, 2007

    anonimouse and anyone else who’s still reading this quite controversial blog.. feel free to read slower and get all the facts and details straight…
    1. Dr. Bill Mitchell was NOT Bastyr University’s president, he was one of the co-founders..
    2. don’t ever judge/formulate conclusions without getting all your researches/facts/stories done… in regards to Dr. Mitchell’s passing, you try loosing your son who’s about half of your age.. see how that feels, eh?

    This has been a very sad/frustrating blog post to read. For those of you who are anti-CAM, ask yourself why and check in the history of “modern conventional medicine” and CAM. Have you tried any of the CAM therapies with open-mindedness? I’d like to think we, collectively as healthcare professionals, are walking towards the future of integrative medicine. No ONE single medicine can serve all the patients/diseases out there. Keep that in mind. And if you’re still strongly anti-CAM, then go ahead and prove that CAM’s just placebo effect and what not. Good luck.

  47. #47 anonimouse
    March 3, 2007

    lemonade,

    There’s no such thing as integrative medicine. If a treatment works, it gets added to a doctor’s repetoire. If it doesn’t work, it won’t. The only people who blather on about so-called “integrated” medicine are people who can’t prove their modalities work yet want the same stature given to them as evidence-based medicine.

    As to my comments about “Dr” Mitchell, I simply find it interesting that one of the kings of the naturopaths (who always go on and on about the toxicity of our society and how natural living is the way to go) died relatively young from a condition commonly associated with, well, unhealthy living.

  48. #48 HCN
    March 3, 2007

    Actually, in all honesty anonimouse, Dr. Mitchell and his son both died of heart conditions very close in time to each other, so there may have been a genetic heart condition that neither of them knew about. (I have a kid with http://www.4hcm.org/WCMS/index.php … a condition that is unfortunately often diagnosed only after “sudden death”).

    But anyway, he was no angel, having been convicted of a DUI:
    http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=mitchellobit27m&date=20070127

    Also, I will admit that Bastyr has a very good cafeteria… and has tried to do actual research. I remember when they announced with full fanfare that there were going to do a full research study on homeopathy. That was over 15 years ago when they were still located in the the old McDonald School near Seattle’s Green Lake. It was that news report on KOMO TV that I first learned what homeopathy was. I have yet to see any publication on the restults of that study from Bastyr — possibly because it did not turn out like they wanted.

    lemonade39, do you know what happened to that homeopathy research study by Bastyr that would have started somewhere around 1991 or so? Did they lose it when they moved to Kenmore?

    Of course, one of the reasons I am interested is that there is an extended family relative who had a psychotic moment enough to get herself placed in Harborview’s psych ward for six weeks. That is where she she was diagnosed as being bipolar, given real meds and some good talk therapy.

    Only after she was released there was no followup so she went back to her Bastyr trained naturapath (one that told her to stay away from foods allergy foods like milk and eggs, and then stick to soy — which turns out is something lots of people are allergic too!). She claimed that the naturapath knew more than the county psychiatrist. That naturapath prescribed homeopathic meds for her, so she stopped her real meds and did what the naturapath told her — only to find herself slipping back into manic and depressive modes again. Fortunately she realized early enough that the homeopathy was worthless and got back onto her real meds again.

    So I really really want to know what Bastyr did with their homeopathy research!

  49. #49 Orac
    March 3, 2007

    Have you tried any of the CAM therapies with open-mindedness? I’d like to think we, collectively as healthcare professionals, are walking towards the future of integrative medicine. No ONE single medicine can serve all the patients/diseases out there. Keep that in mind. And if you’re still strongly anti-CAM, then go ahead and prove that CAM’s just placebo effect and what not. Good luck.

    Ah, the old “Don’t knock woo ’til you’ve tried it” doggerel coupled with a “science doesn’t know everything” canard. You’ll really have to do much better than that. As we say, being open-minded is good, but don’t be so open-minded that your brains fall out.

    You’re also shifting the burden of proof. In medicine burden of proof is on the one advocating a therapy to produce evidence that it works. It is not up to me or any other skeptic to “show that it works.” So, if you think this stuff works so well, please, by all means, show us the evidence. As I’ve said before, I reject the term “alternative medicine” as a false dichotomy. There should just be medicine that has valid scientific evidence of efficacy, regardless of what it is or where it comes from or whether it was considered “alternative” or not.

  50. #50 Cedron
    March 3, 2007

    I hear people on this post asking for proof of the efficacy of non-western or otherwise ‘alternative’ medical treatments through the use of western systems of proof. That is, double blind randomized placebo controlled studies. But I also hear people trying to point out that this approach may not be the appropriate method to proving efficacy, given that the systems of medicines themselves stem from a completely different world view. GoBlue for example, asks, can you read Chinese? There is a valid point in GoBlue’s question. There are indeed thousands of DBRPC trials currently being performed in China, the vast majority of which will in fact never be translated to English. Ask yourself, how many translations of clinical trials will you read before you are satisfied with the ‘proof’. And as for homeopathy – a concept born in western civilization – while it is true that the doctor who originally came up with the idea of distilling the solutions to miniscule amounts also thought the medicine required beating a bible and chanting religious slogans into the medicinal solution seems a little bit wierd, but upon examining the clinical trials involving prayer, one can see that there may be forces at work that we still don’t understand or know how to measure.

    Insisting on the same method of proof for systems of medicine that are rooted in entirely different concepts of physiology and indeed in some cases anatomy, is a little like throwing the baby out with the bathwater. In our lifetimes, technology has grown leaps and bounds, resulting in medical achievements that the previous generations thought to be impossible. See http://www.physorg.com/news91887513.html for a news story on the potential of nerve regeneration, something my father, a retired anesthesiologist still swears is impossible. I think we take for granted the fact that what we ‘know’ today, will be old outdated information tomorrow. Sarken wrote about finding a way to measure qi ‘in a teaspoon or by the cc’, and again he/she has a point, that we still haven’t found a way to measure this ‘energy’. Not having a way to measure it doesn’t mean it’s not there. And while Sastra points out, “[if] there really is qi energy and it really does heal, then *shame* on them for having the arrogance to promote it uncritically before it was adequately tested and confirmed.” But why should the world have to wait for western trained physicians to be satisfied with the results of studies designed for and by them? Acupuncture for example has been in use longer than christian prayer and while this doesn’t prove anything, it certainly points to some form of comfort to the individual, whether it is a sense of control over their own health or actual physiologic benefits. Or, for that matter physiological benefits from having a sense of control over their own health!!!

    While we all want the best possible care for our patients, most of the so-called ‘alternative’ treatments, when performed by trained professionals are harmless at worst, efficacious at best. Garret wrote, “we’re learning how to keep our patients from killing themselves with their vodka/black cohosh martinis they drink every morning during their yoga session… ” Another point well made, when patients come up with self treatment plans without knowledge of herb/drug interactions, dangerous reactions can result. On the other hand, the impetus for drug/herb interaction is actually on the trained herbalists who always have to default to western trained physicians, legally and to some degree morally because modern pharmaceuticals are generally so much more powerful than herbs. Indeed there are laws in the United states regarding the treatment of cancer with herbs, while in countries like china the use of herbs are routinely used as complementary care in the treatment of cancer.

    It would behoove us to remember that the human body is the most complex and miraculous thing on earth. We, as western trained medical professionals do not have all the answers, and as lemonade39 pointed out, no one medicine can serve all the patients or treat all the diseases out there. From my own clinical experience I know this much to be true

  51. #51 Peter Moran
    March 3, 2007

    It looks as though the argument about alternative methods is going to be permanently seized up upon mechanistic questions.

    Surely there is now more than enough evidence to show that alternative methods, to the extent that they work at all, all work much the same way and for roughly the spectrum of medical conditions, and possessing a similar *inability* to have reproducible effects on any important disease process.

    In short, with the probable exception of some herbs, they all work as any rather sophisticated placebo medicine might, helped along by the unique mystiques, the ability to meld with outlying world views, and the ability of absolutely any kind of medical nurture to satisfy many of the complex needs that folk bring into medical consultations.

    So the most relevant question is surely whether such placebo medicines have a useful role in society. It can be argued that they probably do, while ever the mainstream lacks simple, safe and affordable and 100% reliable solutions for all medical conditions and for everyone.

    Alternative medicine can be criticised for many things and there needs to be a very tight reign on the claims that it is allowed to make, but can we yet say that it serves no function in a society that is only a century or so away from a medicine dominated by equivalent ancient superstitions and has always had a sizeable undercurrent of folk and “quack” medicine?

    Once we have the answer to this question we can look at what medical schools should be teaching and how they do it. There is no doubt there needs to be some knowledge taught about alternative methods while ever their use is so prevalent and when so many doctors are themselves using them alongside scientific medicine (60% of Scottish doctors use homeopathy).

    This is where I am “seized up” on this question!

  52. #52 khan
    March 3, 2007

    It would behoove us to remember that the human body is the most complex and miraculous thing on earth.

    Facts not in evidence.

    There are degrees of miraculous?

  53. #53 Sithara Batcha
    March 4, 2007

    For those against ALL ‘woo’ (the hardliners)…

    Are you willing to toss out the 40% of modern medicine (actually, this number seems too low to me, but I’ll leave it for the sake of argument) that is not evidenced based until it has all been ‘proven’ by double-blind randomized trials? Toss out most of surgery…

    And why should double-blind randomized trials be enough anyway? Ultimately, perhaps its still all woo! Don’t you want to, need to, know the mechanism of action all the treatments you prescribe? If so, are you willing to toss out many many pharmaceuticals, including pain killers like acetaminophen, many psychotropics and anesthetics, until we know exactly how they work?

    Good luck in your medical practice.

  54. #54 Orac
    March 4, 2007

    Are you willing to toss out the 40% of modern medicine (actually, this number seems too low to me, but I’ll leave it for the sake of argument) that is not evidenced based until it has all been ‘proven’ by double-blind randomized trials? Toss out most of surgery…

    Nice try, but that’s one of the oldest and most facile strawman arguments there are on this topic. (It’s also quite tiresome.)

    Evidence-based medicine does not consist solely of double-blind randomized clinical trials, as (I hope) you well know. If you do not, then here’s some education (I’ve written about this many times before) about what EBM is and what EBM is not.

    And, once again, even if we were to accept the figure that “40% of conventional medicine is not evidence-based” (which, I might add, is an improvement over previous estimates that I heard a decade ago, implying to me that we must be doing something right), then that is an impetus to improve conventional medicine my lowering that percentage, not a justification that it’s OK to use evidence-free and scientifically plausible modalities. In fact, doing so would increase the amount of non-EBM in conventional medicine, leading me to think that you, as another commenter by the ‘nym GoBlue who made exactly that same tired argument (that I answered), don’t give a rodent’s posterior about how much of conventional medicine is evidence-based and use that figure only as a convenient means of justifying the use of woo.

    Oh, and you should really read the rest of the comments before embarrassing yourself by repeating the same argument.

    As for your last comment about acetominophen, etc., that’s a huge strawman too. I never said we should throw out medicines because we don’t yet know all their mechanisms, and the reason is because we know that they do work and we have reasonable ideas of physiological and pharmacological mechanisms by which they work.

    Really, I think your two arguments are deserving of being placed in the “You might be an altie if…” list. I guess I should be grateful that, unlike GoBlue, you didn’t accuse me of racism.

  55. #55 David Brown
    March 7, 2007

    If you want to argue that modern medicine can learn from ancient practices, folk medicine, or non-Western approaches, I’ll buy that – if by ‘learn’ you mean ‘scientifically determine the efficacy of such practices’, as opposed to ‘uncritically accept unsubstantiated claims and anectdotes’.

    If you haven’t read it, I recommend Honey, Mud, Maggots, and Other Medical Marvels. It discusses various folk remedies (such as using honey or maggots on wounds), their history, and their efficacy in a modern context. What is important is that the authors don’t simply blather on about all the neato anectdotes they’ve heard about these wonderful ‘alternative’ approaches, they look at the studies and trials that have been done on these practices. They state:

    Our ultimate criterion has been, in fact, that accredited physicians working in established hospitals in industrialized countries use the treatment, or some historical offspring of the treatment, today. We firmly believe that medicine can benefit from folk wisdom only if the very highest clinical standards are maintained.

    The authors certainly criticize modern medical practioners for not paying more attention to historical medical practices (water therapy, for example, has been shown scientifically to be more useful than stereotypes of gouty Victorians ‘taking the waters’ might make us think), but they know quackery when they see it – homeopathy being an excellent example of such.

    I try to have an open mind on medical practices – but not a gaping one.

  56. #56 anonimouse
    March 7, 2007

    And as for homeopathy – a concept born in western civilization – while it is true that the doctor who originally came up with the idea of distilling the solutions to miniscule amounts also thought the medicine required beating a bible and chanting religious slogans into the medicinal solution seems a little bit wierd, but upon examining the clinical trials involving prayer, one can see that there may be forces at work that we still don’t understand or know how to measure.

    Not there aren’t. There are holes in the clinical trials involving prayer so big you can drive ten trucks through them.

  57. #57 Louis Dixon
    March 17, 2007

    “I honestly don’t understand. Where is all this woo coming from, and why are medical schools suddenly becoming so susceptible to it?”

    A long time ago, before he died, Jeff Raskin was warning us about nursing cults. As crazy as it sounds, you can find a few people mentioning the mix of cults and medicine (here and there) but, otherwise, people with weird credentials – and who need to be retrained – have been functioning, pretty much, under the radar,…precisely because so many doctors don’t take the idea seriously – despite the fact they see so many of them.

    I’ve got many thoughts on this but I’ll leave you with this one:

    It’s those on the periphery of believers who are always in the most danger.

    Louis Dixon
    The Macho Response

  58. #58 Peter Moran
    July 6, 2007

    Let’s be very wary about sending the message that such studies would be satisfactory proof of homeopathic activity if we were unable to find fault with them.

    Peter Moran

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